RT Book, Section A1 Gomella, Tricia Lacy A1 Cunningham, M. Douglas A1 Eyal, Fabien G. A1 Tuttle, Deborah J. SR Print(0) ID 1107524777 T1 Perinatal Asphyxia T2 Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, 7e YR 2013 FD 2013 PB McGraw-Hill Education PP New York, NY SN 9780071768016 LK accesspediatrics.mhmedical.com/content.aspx?aid=1107524777 RD 2024/03/28 AB Perinatal asphyxia is a condition of impaired blood gas exchange that, if persistent, leads to progressive hypoxemia and hypercapnia. Hypoxic-ischemic encephalopathy (HIE), which is a subset of neonatal encephalopathy (NE), can result from perinatal asphyxia.Neonatal encephalopathy (NE) is clinically defined as a disturbance in neurologic function demonstrated by difficulty in maintaining respirations, hypotonia, altered level of consciousness, depressed or absent primitive reflexes, seizures, and poor feeding. NE does not imply HIE. NE may represent a metabolic disorder, infection, drug exposure, or neonatal stroke, but it is the preferred terminology to describe a depressed newborn from any cause at the time of birth.In order for an acute intrapartum hypoxic event to be considered a cause of cerebral palsy (CP), the American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology (ACOG) define 4 essential criteria that must be met:Evidence of a metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH <7 and base deficit ≥12 mmol/L).Early onset of severe or moderate neonatal encephalopathy in infants born at 34 or more weeks of gestation.CP of the spastic quadriplegic or dyskinetic type.Exclusion of other identifiable etiologies, such as trauma, coagulation disorders, infectious conditions, or genetic disorders.Criteria that collectively suggest an acute intrapartum hypoxic event (within 0–48 hours to labor and delivery) but are individually nonspecific to asphyxial insults:A sentinel hypoxic event occurring immediately before or during laborA sudden and sustained fetal bradycardia or the absence of fetal heart rate variability in the presence of persistent, late, or variable decelerations, usually after a hypoxic sentinel event when the pattern was previously normalApgar scores of 0–3 beyond 5 minutesOnset of multisystem involvement within 72 hours of birthEarly imaging showing evidence of acute nonfocal cerebral abnormality